Mr. D accompanies his wife to the clinic. He appears healthy and has no history of risk factors for infertility (normally descended testes, no history of STDs, no history of mumps). He has no children from previous relationships. As per his primary care provider, his prostate exam was normal. Mr. D has a semen analysis and returns to the clinic with his wife three weeks after their initial visit.
Sperm Concentration: 30 million/mL
Motility: 50% Type A&B
Morphology: 50% normal forms
Day 3 FSH: 15; AMH: 4; TSH: 7
Normal semen analysis
High FSH – 15 (indicating patient is headed toward menopause; normal=3–8)
Normal AMH (indicating good ovarian reserve)
High TSH indicating hypothyroidism (can stimulate prolactin and lead to anovulation)
Mr. and Mrs. D are engaged in a discussion about how aggressive they want to be. Mrs. D is recommended a trial of clomiphene citrate to induce ovulation. Her TSH is checked again and a prolactin level is requested. The couple is advised to continue timing coitus and to await results.